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Biodefense is a fascinating field that marries public health, political science, policy, and science. While we used to think of biodefense as a response to bioterrorism, recent years have expanded its role to account for all infectious disease threats, regardless of origin.

The infectious disease threats facing the U.S. and the world require us to venture outside our historical comfort zone. Here are just a handful of the “hot topics” (pun intended) we face in biodefense efforts.

Naturally occurring infectious disease outbreaks
While this may seem straight-forward, the truth is much more complex. We still struggle to respond to diseases that we’ve either vaccinated against or have treatment readily available. Measles outbreaks, like that in Disneyland or currently plaguing Europe, and the yellow fever vaccine shortage are all avoidable public health events. Prevention and response efforts are also consistently lacking and subject to government funding woes. These issues don’t even touch on the threat of emerging infectious diseases that we have little experience in identifying or treating.

Simply put, we’re still struggling to respond to naturally occurring outbreaks, whether it be a vaccine-preventable diseases or emerging infections.

Antimicrobial resistance
This is perhaps one of the most under-appreciated and high-threat issues to face global health security. If bioterrorism is viewed as a low probability, high consequence event, then antimicrobial resistance is a high probability, high consequence reality. We’re nearing the edge of the antibiotic abyss, and efforts to spark innovation for drug development are still lacking. Strategies to strengthen antibiotic stewardship and decrease unnecessary usage are struggling against the lack of international surveillance programs, limited international regulations, agriculture usage, and medical tourism.

Growth of national biodefense programs
The threat of bioterrorism and infectious diseases has encouraged many states to develop biodefense programs. While global health security is extremely important, a poorly developed national biodefense program can bring more perils than prevention. A lack of transparency and dual-use research can trigger foreign governments to worry that the biodefense program is actually a cover for an offensive bioweapons program. Poor biosecurity and biosafety at facilities can also result in exposures and increase the risk for dangerous events. The more programs that exist, the more room for error, especially in countries that struggle with stability and fail to maintain transparency.

Poor hospital infection control
Most preparedness plans focus on surge capacity and availability of health professionals, but they fail to really address the problem; infection prevention and control. A hospital can have a large surge capacity, but if it can’t maintain basic precautions and safety isolate infectious patients, it will only fuel an outbreak. The healthcare-acquired cases of Ebola in Dallas, TX were prime examples of poor infection prevention practices. Moreover, infection prevention programs are a direct link between healthcare and public health reporting. Continued neglect of hospital infection control only contributes to rising antibiotic resistance, delayed infectious disease reporting and isolation, and poor preparedness.

Synthetic biology
The biotechnology revolution is booming and oversight is racing to catch up. Technologies like CRISPR-Cas9 make genomic editing easier, cheaper, and more accessible, which has created a new wave of do-it-yourself biohackers. While this technology has the potential for combatting diseases, it also is widely available, and may worry that it could easily be used for nefarious purposes. The ease of use and availability of mail-order organisms means that a biohacker could genetically modify an organism to be more virulent, resistant to treatment, or even more transmissible. While the biotech industry is constantly growing and breaking barriers, efforts to form and maintain oversight are lagging.